Provider Demographics
NPI:1063773448
Name:SPIVEY, HERMAN EVERETTE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:HERMAN
Middle Name:EVERETTE
Last Name:SPIVEY
Suffix:
Gender:M
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14770 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-5252
Mailing Address - Country:US
Mailing Address - Phone:281-977-8365
Mailing Address - Fax:281-493-3353
Practice Address - Street 1:14770 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-5252
Practice Address - Country:US
Practice Address - Phone:281-977-8365
Practice Address - Fax:281-493-3353
Is Sole Proprietor?:No
Enumeration Date:2012-06-02
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX738016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX308184501Medicaid